Provider Demographics
NPI:1871872788
Name:SZACHACZ, JEAN (MA CCC-SLP)
Entity type:Individual
Prefix:MS
First Name:JEAN
Middle Name:
Last Name:SZACHACZ
Suffix:
Gender:F
Credentials:MA CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:56 2ND AVE
Mailing Address - Street 2:
Mailing Address - City:HADLEY
Mailing Address - State:NY
Mailing Address - Zip Code:12835-2229
Mailing Address - Country:US
Mailing Address - Phone:518-696-5079
Mailing Address - Fax:
Practice Address - Street 1:273 LAKE AVENUE
Practice Address - Street 2:
Practice Address - City:LAKE LUZERNE
Practice Address - State:NY
Practice Address - Zip Code:12846
Practice Address - Country:US
Practice Address - Phone:518-696-2112
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-08-09
Last Update Date:2011-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY011187-1235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist